Papilloedema

Published on 02/04/2015 by admin

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Last modified 02/04/2015

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203 Papilloedema

Instruction

Examine this patient’s fundus.

Salient features

History

• Headache

• Transient visual disturbances

• Diplopia (from associated sixth cranial nerve palsy)

• History of hypertension, brain tumour

• History of ingestion of steroids, hypervitaminosis A (causes of benign intracranial hypertension).

Examination

• There is swelling of the optic disc (look for haemorrhages and soft exudates; Fig. 203.1).

image

Fig. 203.1 Papilloedema.

Note: Common causes are:

• Intracranial space-occupying lesion

• Hypertensive retinopathy

• Benign intracranial hypertension.

Diagnosis

This patient has bilateral papilloedema (lesion) and I would like to investigate for an intracranial space-occupying lesion (aetiology).

Questions

What do you understand by the term papilloedema?

Papilloedema is the swelling of the nerve head as seen on ophthalmoscopy. The colour of the disc becomes redder, approximating to that of the rest of the retina; its contour becomes blurred and the cup and cribrosa are filled in.

What is the first manifestation of papilloedema?

The earliest manifestation of papilloedema is the engorgement of the veins.

What is the nature of the field defect in papilloedema?

Papilloedema is always associated with enlargement of the blind spot, with a consequent diminution of visual fields and gradual loss of visual acuity, but a fair degree of acuity may remain until papilloedema is marked.

Advanced-level questions

Mention a few causes of papilloedema

• Raised intracranial pressure resulting from one of the following conditions:

• Impaired circulation of the CSF in aqueduct stenosis
• Meningitis
• Subarachnoid haemorrhage.

• Cerebral oedema:

• Following head injury
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